Dual Use of VA and Non-VA Healthcare Services Among Veterans Younger than 65

65 岁以下退伍军人双重使用 VA 和非 VA 医疗服务

• 批准号: 8398618
• 负责人: MARY E. CHARLTON
• 金额: --
• 依托单位: WHITE RIVER JUNCTION VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-11-01 至 2015-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8398618
• 关键词: Address; Admission activity; Age; Amputation; Area; Caring; Categories; Characteristics; Code; Conflict (Psychology); Data; Data Element; Data Set; Data Sources; Databases; Diagnosis; Diagnostic; Diagnostic Procedure; Disabled Persons; Elderly; Enrollment; Family; Gender; Health; Health Care Reform; Health Insurance; Health Services Accessibility; Health system; Healthcare; Healthcare Systems; Home environment; Hospitalization; Image; Imaging Techniques; Improve Access; Information Systems; Inpatients; Insurance; Iowa; Knowledge; Life; Logistic Regressions; Maine; Medical; Medicare; Mental Health Services; Methods; New Hampshire; Occupations; Outcome; Outpatients; Patients; Pattern; Pharmaceutical Preparations; Pharmaceutical Services; Pharmacy facility; Policies; Population; Post-Traumatic Stress Disorders; Private Sector; Procedures; Process; Provider; Quality of Care; Records; Research Personnel; Resource Allocation; Resources; Risk; Rural; Services; Source; South Dakota; Strategic Planning; System; Therapeutic; Time; Traumatic Brain Injury; Veterans; Woman; Work; adverse outcome; care systems; cost; demographics; design; evidence base; human old age (65+); improved; meetings; men; programs; residence; wasting

DESCRIPTION (provided by applicant): Background: VA enrollment has been extended to OEF/OIF/OND Veterans for a minimum of five years, and as a result, enrollment has grown sharply. Unprecedented proportions of these newer enrollees are Reservists or National Guardsmen returning to or finding jobs with private health insurance. Their capacity to use both VA and private sector care is unparalleled among Veterans under 65, and studies suggest that roughly half may be "dual users." Dual use of health care systems raises several concerns, including discontinuity in care, duplicative treatments, and increased costs, but few studies have examined potential adverse outcomes of dual use. Because obtaining private insurance claims information is difficult, no studies have comprehensively examined dual use and associated outcomes among VA enrollees younger than 65 who have private insurance. Knowledge of dual use patterns could substantially enhance efforts to achieve three of Secretary Shinseki's top priorities: 1) strengthening access for rural Veterans, 2) expanding health programs for women Veterans, and 3) improving the quality, access, and value of mental health services. The proposed study will advance our understanding of how younger Veterans in rural states use VA, the private sector, or both systems for particular services and needs, and whether dual use is associated with benefits or risks. Objectives: Quantify the extent of VA, private sector and dual health care use among VA enrollees with private insurance, determine associations between dual use and demographics such as gender, urban-rural residence, distance to care, illnesses and health system factors, and evaluate differences in quality of care received by dual users compared to single system users, such as receipt of recommended treatments for post traumatic stress disorder and occurrences of therapeutic duplication or redundant procedures (e.g. high-cost imaging). Methods: We will assess comprehensive utilization patterns of VA enrollees with private health insurance who are younger than 65 and living in four states from 2001 through 2010 (available years vary by data source). We will obtain non-VA claims data from Wellmark BCBS of Iowa and South Dakota, and from the New Hampshire and Maine All Payer Claims Databases. Under a method we have applied previously, VA's National Data Systems (NDS) will provide each of the non-VA data sources with identifiers for all enrollees living in the state at any time during relevant years; the sources will use the identifiers to search for matching records, along with a non-reversible unique ID (UID). Matching records will be sent to NDS with the UID for each patient, but without SSNs or birthdates. The UID will be the only identifier the investigators will receive, but it will enable them to detect dual users without compromising sensitive patient information. Data elements will include demographics, inpatient and outpatient claims (including diagnosis and procedure codes) and pharmacy data; Poisson and logistic regressions will be used to compare VA-only, private sector-only, and dual users on utilization rates, receipt of recommended, quality care, occurrences of avoidable admissions and readmissions, and duplicative care related to medications and imaging, controlling for urban-rural residence, distance to care, gender, VA priority status, diagnostic categories, and types of medical services.

描述（由申请人提供）： 背景：VA入学率已扩展到OEF/OIF/OND退伍军人至少五年，结果，入学率急剧增长。这些较新的入学者的前所未有的比例是预备役人员或国民卫生，他们返回或找到私人健康保险的工作。他们使用VA和私营部门护理的能力在65岁以下的退伍军人中无与伦比，研究表明大约一半是“双重用户”。双重使用医疗保健系统引起了一些问题，包括护理中的不连续性，重复治疗和成本增加，但很少有研究检查了双重使用的潜在不利结果。由于难以获得私人保险索赔信息，因此在65岁以下的有私人保险的VA参与者中，没有进行全面研究双重使用和相关结果。对双重使用模式的知识可以大大加强努力，以实现Shinseki秘书的三个首要任务：1）加强农村退伍军人的机会，2）扩大女性退伍军人的健康计划，3）提高心理健康服务的质量，获取和价值。拟议的研究将促进我们对农村国家年轻退伍军人如何使用VA，私营部门或两个系统的特定服务和需求系统的理解，以及双重使用是否与利益或风险有关。目标：量化VA参与者中VA，私营部门和双重医疗保健的范围，确定双重使用和人口统计学之间的关联，例如性别，城市农村居住，护理距离，护理距离，疾病和卫生系统因素，以及评估与单个系统用户相比的护理质量的差异，例如接受的治疗范围，例如收到的范围，以置换率，例如收到的范围。程序（例如，高成本成像）。方法：我们将评估VA参与者的全面利用模式，其私人健康保险年龄在65岁以下，从2001年到2010年居住在四个州（可提供的年份因数据源而异）。我们将从爱荷华州和南达科他州的BCB，新罕布什尔州和缅因州所有付款人索赔数据库中获得非VA索赔数据。根据我们以前应用的方法，VA的国家数据系统（NDS）将为每个非VA数据源提供标识符，以适用于相关年份中任何时候居住在该州的所有参与者；来源将使用标识符以及非可逆唯一ID（UID）搜索匹配记录。匹配记录将与UID一起发送给ND，但没有SSN或生日。 UID将是调查人员将是唯一的标识符 接收，但这将使他们能够检测双用户而不会损害敏感的患者信息。数据元素将包括人口统计学，住院和门诊索赔（包括诊断和程序代码）和药房数据； Poisson和Logistic回归将用于比较仅VA，仅私营部门和双重用户的利用率，收到推荐的，优质的护理，可避免的入院和重新录取和重复的护理以及与药物的重复护理以及与药物和想象相关的，对城市种植居住的距离，距离护理，距离护理，远距离护理，范围的服务，va va Prestical satect，va nightic and诊断。